Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
J Med Internet Res. 2023 Sep 22;25:e45695. doi: 10.2196/45695.
Sexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility.
We aim to systematically identify and assess web-based STI/HIV testing services available in Australia.
A Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results.
Seventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus $0-$595; ie, US $0-$381.96), self-sample (Aus $0; ie, US $0), and ST (Aus $0-$135; ie, US $0-$86.66). The time to test results was much shorter for SNP services (4 days) than for SS (12 days) and ST (~14 days).
This review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests.
性传播感染 (STI) 率在澳大利亚持续上升，及时进行检测和治疗对于减少传播至关重要。网络服务被视为改善 STI/HIV 检测及时性的一种方式，近年来已经大量涌现。然而，澳大利亚对这些服务的监管很少，这引发了人们对其质量的担忧。本研究的目的是系统地识别澳大利亚提供的网络性传播感染/艾滋病病毒检测服务，并评估其在质量、可靠性和可及性方面的表现。
我们旨在系统地识别和评估澳大利亚提供的网络性传播感染/艾滋病病毒检测服务，并评估其质量、可靠性和可及性。
我们于 2022 年 3 月和 2022 年 9 月使用与测试服务（例如互联网或家庭）、性传播感染（例如衣原体或淋病）和测试类型（例如自我检测）相关的布尔运算符和搜索词，对澳大利亚网络服务进行了谷歌搜索。评估了前 10 页的内容，并将服务分为自我检测（ST；在家中进行检测）、自我采样（SS；在家中采样并送回实验室）或自我导航病理学（SNP；在病理中心采集标本）。我们根据健康在线基金会行为准则评估了网站的可靠性，并使用根据类似评论、澳大利亚现场服务指南和英国标准制定的评分卡评估了服务质量。此外，我们还研究了包括成本、农村可及性和检测结果时间在内的可及性措施。
共发现 17 项服务（8 项 ST、2 项 SS 和 7 项 SNP）。只有 4 项服务提供了针对所有 4 种感染（衣原体、淋病、梅毒和艾滋病病毒）的建议检测，包括生殖器、肛门直肠和口咽部位，5 项服务提供了澳大利亚检测指南推荐以外的检测（例如解脲脲原体）。9 项服务（1 项 SNP，8 项自我检测）没有最低年龄要求。可靠性评分（0-8 分）在所有服务之间相似（范围 4.75-8.0）。质量加权评分（0-58 分）在 SNP 和 SS 服务之间相似（平均分别为 44.89、SD 5.56 和 44.75、SD 1.77），但 ST 服务的评分较低（22.66、SD 8.93；P=.002）。政府资助的服务质量高于私人服务（43.54、SD 6.71 与 29.43、SD 13.55；P=.03）。服务费用在 SNP（澳元 0-595；即，美元 0-381.96）、自我采样（澳元 0；即，美元 0）和 ST（澳元 0-135；即，美元 86.66）之间有所不同。SNP 服务的检测结果时间（4 天）明显短于 SS（12 天）和 ST（~14 天）。
本研究发现澳大利亚网络性传播感染/艾滋病病毒检测服务在质量和可靠性方面存在很大差异。鉴于这些服务的使用和普及程度可能会增加，澳大利亚制定国家标准以确保网络性传播感染/艾滋病病毒检测服务提供的护理标准符合要求，以保护澳大利亚用户免受性能不佳和不适当检测的影响至关重要。
